Degenerative disk disease
What is it?
Degenerative disc disease (DDD) is a pathology affecting the intervertebral disc, predominantly in the lumbar spine, characterised by progressive dehydration and thinning of the disc itself. The resulting mechanical instability may be associated with pain and radicular disorders, with highly variable clinical and age-related characteristics.
Which are the symptoms?
Initially, the low back pain is mild and disappears after rest. Over time, it can become increasingly severe and disabling, leading to a marked reduction in quality of life.
How is it diagnosed?
The neurological examination serves to rule out a radicular lesion The radiological examinations to be requested from the patient to make the diagnosis are as follows:
a. Standard radiographs (Rx lumbosacral spine 2P in orthostasis, if necessary Rx lumbosacral spine in dynamic projections of maximum flexion and maximum extension - whole spine in orthostasis when indicated)
MRI: residual disc thickness, degree of disc degeneration (Pfirrmann classification 1-5), inflammatory oedema of the limiting vertebrae (Modic classification), exclusion of infection (spondylodiscitis), radicular compression/conflict). For preoperative planning MRI is necessary to study the lumbar plexus in the context of m psoas and abdominal vessels. Computed tomography: needed to assess canal diameter, pedicle and vertebral body morphology and size, isthmus defects (spondylolysis or lengthening/fracture), disc gas degeneration, degree of degeneration of facet joints, osteophytes/endocanal calcifications.
How is it treated?
The non-surgical treatment pathway
It consists of anti-inflammatory drug therapy, analgesic therapy, corticosteroid therapy, infiltration therapy when indicated, physiotherapy when indicated, and modification of physical activity that can cause strain on the spinal axis when indicated.
Patients with DDD are indicated for surgical treatment if they have disabling pain symptoms that are resistant to medication and physical therapy, have been present for at least 3 months, and especially if the pain irradiates to the lower limbs with or without the presence of neurological claudication or neurological deficits.
The main purpose of the surgery is interbody fusion of the affected area of the spine, which serves to prevent pathological movement between the two vertebrae and to reduce/relieve pain syndrome.
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